China's Deadly Smoking Habit

China’s smoking population is in for a rude awakening in light of a new study from The Lancetmedical journal. The study warns that if current smoking rates in China prevail, two million Chinese will die by 2030.

While the news quickly made headlines throughout the weekend in the Western media, it hardly ruffled feathers in the Chinese media. Most news sources, including the state organ Xinhua, merely regurgitated the results of the study. A post about the news from famous Chinese-American singer Wang Li Hong on the Chinese Twitter-equivalent Weibo, while garnering over 5,000 comments within 24 hours, had mixed reactions. Amidst the admonitions against smoking, there was no lack of speculation about the statistics put out by the medical journal, in addition to apathetic comments like, “This has me scared to death, let me go smoke to de-stress.”

As China Daily reports, smoking has over the decades become a cultural tenet in China. Cigarettes, beyond serving as a means to de-stress, are customarily used as gifts in professional and personal encounters. As described by one Chinese official, “like drinking, if you don’t smoke while everyone else around you is smoking, it complicates your work because you won’t be able to blend in, and over time you may find yourself ostracized.”

Myths about tobacco and its use have hindered the impact of health education messages in China. There are widespread beliefs that it is easy to quit smoking, that biological mechanisms specific to Asians make smoking less harmful, and that tobacco use is an intrinsic part of Chinese culture.

While awareness of the health hazards of smoking is rising among the Chinese populace, overall awareness is still disconcertingly low. According to the World Health Organization (WHO) only 25 percent of Chinese adults have a comprehensive understanding of the health risks of smoking, and less than a third are aware of the dangers of second-hand smoking. In light of these statistics, it is unsurprising that less than 10 percent of Chinese smokers quit by choice and that Chinese people are beginning to smoke at younger ages. Perhaps most alarmingly, a 2013 WHO survey found that among five to six year-olds, almost 90 percent can recognize at least one cigarette brand and 20 percent expect to be smokers when they become adults.

Hindering public health efforts to reduce tobacco smoking is the fact that China is the world’s largest consumer, manufacturer, and grower of tobacco. The China National Tobacco Corporation (CNTC) — an arm of the State Tobacco Monopoly Administration — provides over seven percent of the national government’s annual revenue through net income and taxes and is responsible for over the livelihoods of over eight million farmers, tobacco retailers, and related employees. This puts the Chinese government in an uncomfortable role: while one government agency — the Health Ministry — tries to restrict tobacco use, all the other agencies benefit from the profits of tobacco sales.

Still, the Chinese government is not blind to the statistics being spewed out by researchers worldwide, and has over the years introduced increasingly stringent restrictions on tobacco use. In 2005, China ratified the WHO’s Framework Convention on Tobacco Control, which includes measures for tobacco advertising, promotion and sponsorship, product disclosures, and public awareness procedures. In December 2013, the government banned Party and government officials from smoking in public places or during official activities. More recently, this April, China banned tobacco advertising on mass media, in public places, and in public vehicles. Individual cities have also taken leaps forward, with Beijing adopting a tough new ban on indoor smoking this past June.

All of these efforts look impressive on paper, but smoking in China shows very little signs of abating. Enforcement is haphazard, and compliance varies even along one street. In interviews done by the New York Times following the announcement of Beijing’s ban earlier this year, locals were either skeptical or apathetic about the enforcement, with several businesses bemoaning a hit to their profits if they took initiative in complying with the ban.

As Lancet reports, there’s still hope. Chinese men can receive great benefits if they quit smoking before the age of 35. For those who have not yet developed a fatal disease, even quitting at later ages offers substantial gains. A promising finding from another nationwide study reveals that there are increasing rates of attempts to quite smoking and successful quitting in municipalities with robust tobacco control programs. That makes Beijing’s attempt at keeping its smoking at bay all the more important.

The Chinese government, despite it all, is getting serious about curbing smoking. In light of growing awareness of the medical and lost-labor costs of tobacco-related diseases — which as of 2010 had overwhelmed the revenue generated by tobacco, according to one study — the Health Ministry has urged the State Council to make proposed tobacco restrictions a “tier one” priority to accelerate their enactment. Earlier this year, amid protests from anti-smoking activists who accused the government getting too cozy with the tobacco industry, the vice-director of the State Tobacco Monopoly Administration, and brother of Chinese Premier Li Keqiang, was removed his post. While there are not yet visible hits to the state monopoly, it seems that the awkward partnership will only get more awkward.

But, as Xu Guihua of the Chinese Association on Tobacco Control says, it will all come down to a cultural shift in China. The ordinary Chinese will need to get involved, since the police can’t be everywhere. Besides, the task of dismantling a national cultural artifact is not something that the state can do alone.